This application is for a first competing renewal of a school-based program designed to reduce morbidity for poor children with asthma by facilitating delivery of guideline-based care and improving adherence to effective preventive asthma medications. In 2006, we implemented the School Based Asthma Therapy (SBAT) trial (R01HL079954) with 530 children from more than 50 urban schools. The primary intervention for the SBAT trial consisted of directly observed administration of preventive asthma medications in school (with dose adjustments according to NHLBI guidelines). Results from this study demonstrate reduced morbidity, decreased absenteeism, and fewer exacerbations for these very high-risk children. This program has the potential to serve as a model for improved asthma care in urban communities, however several factors limit dissemination of the program in its current form. For example, extensive resources were required for screening and implementation of the program, and communications with providers for ongoing monitoring of symptoms were inefficient, often delaying recommended medication adjustments. In order for this program to have sustainable public health impact, we must now test a system that allows for full integration within the school and community systems that serve these children. In this new application we propose the next phase in our research, which represents a critical step in our expanding partnership with the city school district. We propose testing a novel school-based program (SB-TEAM - School-Based Telemedicine Enhanced Asthma Management), which directly builds on our prior work, for children with persistent asthma in Rochester City Elementary Schools. We recently developed and pilot-tested the technology for web-based screening and communication for this intervention (RC1HL099432), and now propose a full-scale trial across an entire school district using this technology with the addition of telemedicin asthma assessments to assure appropriate follow-up care and optimal treatment. We hypothesize that children receiving care through SB-TEAM will experience less asthma- related morbidity compared to children in an enhanced usual care (eUC) comparison group. Further, we anticipate that the benefits will be even greater than those seen in the original SBAT trial, due t the ability to more optimally tailor each child's medication regimen. The SB-TEAM program includes systematic web-based asthma screening, directly observed administration of preventive asthma medications in school, and ongoing monitoring and tailoring of the care regimen using school-based telemedicine. Children in the eUC group will receive asthma screening with notification of their PCP, as well as systematic feedback to the parent and provider to promote appropriate guideline based follow-up care. This application represents a logical extension of our work to improve adherence to effective asthma medications that can reduce health disparities and could ultimately be sustained in communities nationwide.